Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?
Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?
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DOI：
10.1007/s00467-018-4044-x
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发表时间：
2019-01-01
影响因子：
3
通讯作者：
Riekert, Kristin A.
中科院分区：
文献类型：
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作者：
Pruette, Cozumel S.;Coburn, Shayna S.;Riekert, Kristin A.
背景医疗提供者对不依从性的评估是不准确的。研究人员建议使用多方法评估方法；然而，还没有研究表明如何整合不同的措施来提高准确性。这项研究的目的是确定是否使用额外的措施可以提高仅使用提供者评估之外的不依从性的准确识别。方法87名年龄11-19岁的青少年和青年(AYA)患有慢性肾脏疾病(CKD)[1-5期/终末期肾病(ESRD)]和开出的降压药，他们的照顾者和17名医疗提供者参与了这项多点研究。获得了5项遵守措施：提供者报告、AYA报告、照顾者报告、电子用药监测(MEMS)和药房再灌装数据[药物持有率(MPR)]。使用Kappa统计量计算一致性。以MEMS作为衡量粘附性的标准，计算敏感度、特异度、阳性预测力和阴性预测力。结果两者的一致性较差(Kappas=0.12~0.54)，35~61%的AYA根据测量结果被归类为未粘附性。虽然提供者和MEMS都将35%的AYA归类为未粘连，但敏感度(0.57)和特异度(0.77)显示这两种方法在识别哪些AYA未粘连方面的一致性较差。结合不遵守规定的提供商报告和MPR
BackgroundMedical provider assessment of nonadherence is known to be inaccurate. Researchers have suggested using a multimethod assessment approach; however, no study has demonstrated how to integrate different measures to improve accuracy. This study aimed to determine if using additional measures improves the accurate identification of nonadherence beyond provider assessment alone.MethodsEighty-seven adolescents and young adults (AYAs), age 11-19years, with chronic kidney disease (CKD)[stage 1-5/end-stage renal disease (ESRD)] and prescribed antihypertensive medication, their caregivers, and 17 medical providers participated in the multisite study. Five adherence measures were obtained: provider report, AYA report, caregiver report, electronic medication monitoring (MEMS), and pharmacy refill data [medication possession ratio (MPR)]. Concordance was calculated using kappa statistic. Sensitivity, specificity, positive predictive power, and negative predictive power were calculated using MEMS as the criterion for measuring adherence.ResultsThere was poor to fair concordance (kappas=0.12-0.54), with 35-61% of AYAs classified as nonadherent depending on the measure. While both providers and MEMS classified 35% of the AYAs as nonadherent, sensitivity (0.57) and specificity (0.77) demonstrated poor agreement between the two measures on identifying which AYAs were nonadherent. Combining provider report of nonadherence and MPR